Article Figures & Data
Figures
- Fig 1.
A 51-year-old woman presenting with Hunt and Hess grade 4 subarachnoid hemorrhage from a previously diagnosed fusiform aneurysm of the basilar trunk. A, Unenhanced CT scan shows diffuse SAH (arrowheads). The arrow indicates the partially thrombosed, fusiform aneurysm. B, The 3D reconstruction image shows a fusiform aneurysm (arrowhead) of the basilar artery with saccular components (arrow). C, Angiogram after placement of a Surpass FD (arrowhead) from the P1 segment of the right PCA to the midbasilar level. Additional coils were implanted. Note filling of the aneurysm (arrow). D, The 6-month follow-up angiogram shows complete occlusion of the aneurysm (arrow) and some intimal hyperplasia along the flow diverter (arrowhead). The mRS had changed from 2 before the SAH to 4 during follow-up. The clinical deterioration was most likely related to the SAH. No new infarcts occurred in the posterior circulation after implantation of the flow diverter.
- Fig 2.
A 29-year-old man presenting with headaches and mild ataxia (mRS 1). A, Sagittal T2-weighted image shows a 32-mm vertebrobasilar junction aneurysm (arrowhead) compressing the medulla. B, Axial T1-weighted image with contrast shows the saccular aneurysm (arrow) and the 2 vertebral arteries (arrowheads) joining the aneurysm. C, The 3D reconstruction image shows a wide-neck (arrow) vertebrobasilar aneurysm with additional dysplastic segments (arrowhead) along the course of the basilar artery. D, Angiogram after placement of 2 Surpass FDs from the midbasilar level to the right vertebral artery. Additional coils were implanted (arrow). The distal segment of the left vertebral artery is occluded with coils (arrowhead). The patient was extubated 2 hours after the treatment and presented with paraplegia and respiratory insufficiency. E, Axial diffusion-weighted MR image (b=1000) reveals a medullar infarct (arrow) within the vascular territory of the left anteromedial group of medullary arteries, most likely related to the voluntary occlusion of the left vertebral artery. F, The 6-month follow-up angiogram shows complete occlusion of the aneurysm (arrow). The left posterior cerebral artery is occluded (arrowhead). The time-of-flight MR angiography shows good collateral filling of the left posterior cerebral artery via the left posterior communicating artery (not shown). Clinically, the patient has improved. He now presents with a mild hemiparesis, slightly slurred speech, and ataxia (mRS 3).
- Fig 3.
Summary of statistical analysis. Univariate model results are along the connecting lines; multivariate model (MVM) results are within the box.
- Fig 4.
Shift from baseline mRS to mRS at follow-up (n = 52).
Tables
Characteristics Patients (No.) 52 Aneurysms (No.) 52 Women (%) 21/52 (41%) Mean age (range) (yr) 54 (16–79) Presentation/indications for treatment (No.) (%) Incidental finding/headaches 20 (38%) Recurrent after coiling/coiling and stenting/failed clipping 16 (31%) Cranial nerve deficit/mass effect 14 (27%) Stroke/transient ischemic attack 7 (13%) Acute SAH 7 (13%) Baseline mRS (No.) mRS 0 20 (38%) mRS 1–2 18 (35%) mRS 3–5 14 (27%) Aneurysm size (n = 51) (%) <5 mm 4 (8%) 5–9.9 mm 13 (25%) 10–20 mm 17 (33%) >20 mm 17 (33%) Aneurysm neck size (mm) Mean (range) 17.5 ± 17.7 (2–90) Location (No.) (%) V4 segment of vertebral artery 20 (38%) VB junction 11 (21%) BT 15 (29%) PCA 6 (12%) Morphology (No.) (%) Wide-neck saccular 12 (23%) Fusiform/dissecting 40 (77%) Treatment No. of flow diverters 1.4 ± 0.7 (range, 1–3) No. of additional coiling 15 (29%) Sex Age (yr) Baseline mRS Location Type Size (mm) No. of FDs Cause of Death Survival Time (days) M 60 3 BT Fusiform 10 1 Ischemic stroke 48 hr after FD treatment 2 M 58 4 BT Fusiform 55 1 Rupture during placement of the FD 7 M 64 2 VB junction Fusiform 90 1 Medullary infarct 15 M 55 3 BT Fusiform 39 3 Stable mRS at discharge; acute brain stem infarct 50 M 57 3 VB junction Fusiform 40 3 Stable mRS at discharge; acute gastrointestinal bleed; clopidogrel was stopped; died of urosepsis 170 M 59 4 VB junction Saccular 55 3 Improved mRS at discharge (mRS 3); follow-up DSA at 7 months; aneurysm patent (>50%); at 8 mo, sudden clinical impairment 242 M 74 3 BT Fusiform 28 2 Stable mRS at discharge; died of pneumonia 388 F 75 3 VB junction Fusiform 30 2 mRS 5 at discharge to a tertiary care facility; died of pneumonia Unknown F 65 1 Vertebral artery Fusiform 8 1 Stable mRS at discharge; died from complications related to brain tumor treatment Unknown ↵a All patients had presented with unruptured aneurysms.
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